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Dear Friends and Fellow Horse Lovers,
As you all know, the few days since I made my first post labeled "Watch your horses closely", the internet has generated a huge response. I have received countless emails and among them have been many with the unique symptoms I described. I want to thank everyone who took the time to write me about what was a painful and emotional experience. Almost mercifully, our yahoo group Whisper_Syndrome locked up yesterday and I have been able to catch up.
I have never said what my education or background is because I do not have a medical background. I am in fact a 59 year old electrical and software engineer and technical writer and have worked in science all of my life. I will not say more about my business as that would give critics room to say I have ulterior motives. As to those who believe this is related to my advocacy for ending horse slaughter, it is. It simply springs from the same deep love of horses and the people who share my feelings that brought me to make this effort. That is the connection and the only connection. I do not sell horses or horse related products, nor have any stock or interest in a pharmaceutical company.
What we have done is initial enquiry. It is not science. Since this initial inquiry has sparked awareness in the veterinary world, that is all we could possibly have hoped to accomplish. I have published a synopsis of the information simply to fill the void while we wait for the results of real science. Bombarding the medical establishment with more speculation will simply cause an "immune response" which has predictably already begun to occur. Real science takes time, so let's let it run.
Altogether I found about 125 cases that I thought looked very compelling. Because I provided the symptoms, some of these could have been the result of suggestive recall. Still others could have been botulism or other diseases, even though I did my best to separate out any that did not have a strong combination of key symptoms. Many of you know that I have told you your case does not look compelling or even likely. Even if these 125 cases were all Whisper Syndrome, this is clearly still not an epidemic.
Furthermore, the involvement of round bales and ground feeding, the possible link to Listeriosis in Icelandic horses, and the clustering since early January lead me to hope and expect that these infections will begin to abate rapidly with the onset of warmer (and hopefully dryer) weather. This should give us all a break and give science time to work. We should continue to watch for horses that show a loss of appetite, and if it does abate then next Winter we should all remember to become more vigilant again, and we should all try to keep feed off the ground.
From this point on the veterinary community will have no interest in circumstantial and retrospective data, but hopefully they will begin to look at undiagnosed cases in the light of what we have found. All we can do now is wait. The information is now on all the veterinary lists. If you sent me a compelling case, or believe you have one, please take the time to ask your veterinarian to address these lists with his or her findings. You should understand that it will take courage for him to do so. As we all predicted there are those who will not want Whisper Syndrome to be anything other than the expected diseases. Those are not scientists, nor are those who are not at least somewhat skeptical. True scientists are open minded skeptics.
If you suffer the loss of a horse to any unknown cause, please have a necropsy performed. This will make it far less likely that someone else will suffer the same loss in coming months and years.
Please send me no further case data or theories as to what this might be. If you want to send me an email saying your veterinarian has reported an interesting case, please do so. I obviously still have an intense curiosity but I will be a bystander now. For those who's vets agreed to be contacted, I have not been able to forward their names so they will need to take the initiative.
The Virginia Tech Veterinary School is declining to make a statement at this time, but my veterinarian has agreed to release his findings as to what occurred at my farm. These will confirm my earlier posts as to our experience. He has asked not to have his name released as he must earn a living. I also must earn a living. At this point we all need to take a breather and get back to business. If we can do this without having generated a conspiracy theory or a cult, then we may have set a new precedent for the use of this wonderful medium.
Out of this I have come to realize how very fortunate I am to have the veterinarian I do. He has been open minded and helpful and I credit him for the fact that I only lost one of my three infected horses.
Thank you and may all your horses know only health, happiness and joy,
John Holland
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Until the veterinary community can get ahead of this, I am posting this final summary of what I have learned. Horses are being treated at this moment that had been unsuccessfully treated as having colic and other disorders, so I have felt it urgent to get this out.
In posting the symptoms of my horses and three at a near by farm I received an enormous number of emails saying that they had seen the same symptoms, and most of these horses had died within 12 hours to 4 days. The symptoms mimic botulism, colic, West Nile, and even Salmonella, but they have certain uncharacteristic elements and the only effective treatments have been with antibiotics. These are consistently effective if given in time. I only have records of three untreated horses surviving and none of these has returned completely to normal. One report from 2002 (a mini) has now been reported as having been diagnosed with Listeriosis and no other necropsy has determined the cause of death other than the symptom of colitis. Therefore it became clear that an outbreak of a largely undiagnosed or misdiagnosed disease is clearly killing horses in the following states:
Florida(2), Georgia(1), South Carolina, North Carolina, Kentucky, West Virginia, Virginia, Ohio, Minnesota, Pennsylvania, Minnesota, Maryland, up state New York, Wyoming, Texas (2), Missouri (1), Arizona (1) and there is a possible case in California. I am only counting the clear matches to multiple distinct symptoms. I have given the number of cases in states with less than three reports only. The largest concentration is in the midatlantic states.
We believe that the disease that we have been calling Whisper Syndrome may in fact be Listeriosis or a new strain of this disease. It is a gram positive bacterial infection most commonly known in Icelandic horses. One death in an Icelandic horse has been reported.
It is common in Canada in sheep, and in the US in goats and other ruminants. It is also found in humans and can be transmitted to pregnant women through infected goat's milk. It is not known if it can migrate between these species. In goats it causes symptoms very similar to that seen in horses, especially the strange neck curl or twist we call the Whisper twist. It also causes a circling behavior and is often called "circling disease". In humans it causes neck pain. It can cause miscarriage in humans and two cases have been reported of mares miscarrying relatively early into symptoms.
Listeriosis causes gastro enteritis and septicemia. This would account for the symptoms that appear to be colic, and for the frequent loose manure and/or foul smelling manure and sometimes breath. Please read the symptoms carefully because it is easily misdiagnosed.
Among the horses it appears to be most prevalent in PMU mares and foals from Canada, but our PMU mare Whisper came from North Dakota and had been with us for a year. It has been speculated that she was a carrier, but she was the second horse infected and the only one to die. If she had been the carrier it is difficult to explain her lack of resistance. It is entirely possible that the apparent PMU connection is due to stressed animals, or the fact that my alert reached more of these horse owners.
Whisper Syndrome has been reported to me in almost every breed and in minis. Since our mare had been here for a year, and no other horses had come or gone, it is possible that this is carried by these horses for long periods of times. The other explanation is that the wet conditions have been such that the organism has spread by other vectors or that it was already present and simply was able to transfer. I personally believe it is transmitted by feeding from the ground or food in contact with the ground and by manure, but that is speculation.
About 80% of all cases involve feeding of round bales. It tends to strike multiple times at a single multi-horse facility often killing three or four horses and leaving others unaffected.
The great majority of cases have occurred since January 1, 2005. This is the same season when Listeriosis is most common in Iceland, largely because this is the time of year that grass silage is fed on the ground. It has also been reported in the warmer months but to a much smaller degree. This could coincide with the fact that fewer round bales are fed during these months. It has been reported in some horses with no round bale access or ground feeding other than grazing. In one case the horses foraged around a manure pile in Winter.
Symptoms:
Not all these symptoms are present in any single case, but many are seen in most cases.
Sudden, uncharacteristic, aggressive events have been reported to have preceded the onset of other symptoms in a number of cases. Whisper attacked me without provocation several days before her onset and then seemed confused over why she had done so. So was I as it was entirely out of character for her. These have all been singular events.
Stage 1 symptoms (4 hours to 2 days):
The most reliable early indication is inability to finish meals or complete lack of appetite. Chewing without swallowing is common.
There are unusual neurological symptoms that are nearly as common.
Strange uncharacteristic, isolated stumble, trip, stretching step, head gesture, or other apparently neurological sign.
One common early characteristic is a strange step that looks either like a stretch or the animal trying to jump over a nonexistent object.
Several people describe the horse as not being able to figure out what to do with its feet.
These symptoms are sometimes subtle enough at first that they are dismissed as being due to age or other factors. Turning head sideways while lying down in apparent peace (not looking at or biting flanks as in colic) is also classic and very common. Pawing at floor of stall, and or circling. Both these symptoms mimic the symptoms of circling disease (Listeriosis) in goats. Change of habitual patterns of behavior / confusion. Glassy eyed look and tendency to wander off and get lost.
Some of these symptoms obviously mimic colic, but rolling and looking back at the sides is rare. They also mimic other disorders ranging from botulism and West Nile to salmonella and have been commonly treated for these. Only the cases that used an effective antibiotic have been successful. Previous to this alert, this was most often done because of a salmonella diagnosis but it could never be cultured.
Horse will commonly lay down to rest in apparent peace during early stage. If they do this at a time or place that is uncustomary, it is a warning. This is often accompanied by the turning of the head sideways both while laying and standing. Nasal discharge has been present in many cases and it contained both fungi and bacteria the one time it was cultured. In several cases this infection has been so severe that it has required multiple flushings. A foul breath and/or manure are common. Bloody nasal discharge has been reported in two cases with otherwise classic symptoms. It is possible that the bacteria enters the horse through its nasal cavity or contaminated hay while foraging near the ground.
Lack of appetite or chewing but not swallowing are universal.
Aversion to water (most but not all cases). Horse may be attracted to water and then react as if shocked when the lips touch it, or they may dabble their lips on the surface without drinking. Water aversion may actually precede other symptoms because dehydration is often seen with first symptoms.
In the great majority of cases there is no elevated temperature, and possibly a subnormal temperature (96-99.8 is typical).
Temperature may spike for a short period in Stage 1 and then drop to normal or very often below normal. A temperature below 95 was reported for a short period. The spike is often either missed or does not occur at all. In three classic cases with otherwise perfect symptoms, there was a persistent temperature between 103 and 106.
Blood work will show drop in lymphocytes.
Heart rate may not be elevated, and may even be depressed in this stage.
Some signs of colic (caused by colitis that results). It is often treated as colic, losing critical time and resulting in death.
Even if your vet is relatively sure you are dealing with colic, have him or her run blood tests immediately or start antibiotics as a precaution until you know what you are dealing with.
Stage 2 symptoms:
Sudden crashing into walls or out of stalls.
Difficulty walking and most frequently refusal to move from a standing position, especially forward.
Difficulty getting up.
Total confusion and glassy eyed look
Tripping and sudden collapse.
Shivering, sometimes with sweating (onset of shock)
Colitis is a symptom which can cause loose manure and septicemia causes foul smelling breath and stools. Bloody stool has been reported in one case which is consistent with severe colitis. Distension of the stomach has been noted both during symptoms and at necropsy. Mild to severe diarrhea is most commonly reported, although very dry fecal material in rectal palpation has been reported.
White count may or may not elevate.
Stage 3 symptoms:
Shock, seizures, erratic breathing, death
Death results in 12 hours to 4 days in most untreated horses. The few survivors who were not given antimicrobials took a week or more to begin to recover.
Approximate survival rates (out of 125):
3 reported survivals in untreated horses. These horse are not fully recovered after several weeks.
2 reported survivals when SMZ (Spectrim or Bactrim) was administered, but disease rebounded in one case.
1 reported survival with 20 CC twice daily of Gentamiacin 30 CC of Probios twice daily (used to treat rebound case above)
2 reported survivals with Tucoprim, unknown dose9 reported survivals with Naxcel (average dose 20 CC twice daily for 5 to 14 days depending on how early symptoms were caught.
2 reported survivals with Naxcel administered IV (advanced cases). Recovery can take 10 days or more.
0 reported survivals with penicillin alone but only one case used penicillin alone.These counts may not be exact because the data is sometimes in several emails and needs more sorting.
Blood work should be done immediately to determine if the antibiotics are indicated. It is not safe to assume you are dealing with colic and not check blood at this time. Many horses have been reported to have been treated for colic and died shortly thereafter.
It strikes multiple horses at a single facility and in most but not all cases it is horses that are eating round bales. It may be inhaled from when feeding from the ground. It does not appear to be communicable from horse to horse, at least directly. It may be communicated via feces but this is only speculation. It strikes where no horses have entered the population for months or years. It strikes in facilities that are well managed and clean.
If there has been the death of one or more horses with these symptoms, it is crucial to watch the others very closely.
If you have a case to report, ask your veterinarian to post it to his lists or contact the state veterinarian. Please do not send me further data as the veterinary community now wants clinical reports. We need scientific data and necropsy reports. If the symptoms were present and a necropsy shows gastro enteritis but no clear sign of the cause of death, please encourage the laboratory to continue to investigate the cause.
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